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Home My WebLink AboutBLDP-22-007251 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u -, CITY YARMOUTH MA DATE 6/16/22 PERMIT# BLDP-22-007251 e tf,.- JOBSITE ADDRESS 14 HOSKING LN OWNER'S NAME LADLEY NATHAN W(LIFE EST) .,v P OWNER ADDRESS LADLEY SHARON L(LIFE EST)14 HOSKING LN SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURFS • FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME Virgilio Silva LICENSE 3t1395 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME VIRGILIO SILVA ADDRESS 155 SUDBURY LN CITY HYANNIS STATE MA ZIP 026012462 TEL FAX CELL EMAIL virgiliomga@hotmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY Yarmouth MA DATE 06/15/22 PERMIT # 1 t — "72- r i . ,, JOBSITE ADDRESS 14 Hosking Lane OWNER'S NAMENathan Ladley POWNER ADDRESS 14 Hosking Lane TEL FAX ; I TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: 0 REPLACEMENT: Li PLANS SUBMITTED: YES NO yj FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUBLiess---war.-------1•011101.a.-- _ CROSS CONNECTION DEVICE r At . DEDICATED SPECIAL WASTE SYSTEM L Y L DEDICATED GAS/OIL/SAND SYSTEM r .__46...._ „,. .,..,_ ' _ ._____A—., . imelel , 1..... , DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ,. . «� �wx... DEDICATED WATER RECYCLE SYSTEM 'i-- DISHWASHER ,� DRINKING FOUNTAIN FOOD DISPOSER � ; -••�•� FLOOR /AREA DRAIN ,,� ' INTERCEPTOR (INTERIOR) j ---t _ . ___ KITCHEN SINK LAVATORY rL 46-.) - ROOF DRAIN L .- II- .. IL - SHOWER STALL ;' 1 -fir- r - SERVICE / MOP SINK v-. _. .- irlosparm;;..._. _ M OM TOILET 1 . 1 �. it '� Ma IMF URINAL IT— 7- if wirrat a WASHING MACHINE CONNECTION M WATER HEATER ALL TYPES _...in _ , — f . � 1 WATER PIPING - - l ,, OTHER By �. :,;--- ;;FZT . _ate �. ,� ''2.1t`- ,fil -- ii INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES - ' NO (- IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY , OTHER TYPE OF INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance w' frrent prevision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .. it ilio Silva -- :„.._— PLUMBER S NAME 9 LICENSE # 1395-J SIGN URE MPL JP CORPORATION # PARTNERSHIP # LC # I COMPANY NAME 1 Silva Plumbing and Heating ADDRESS 155 Sudbury lane CITY Hyannis — STATE MA I ZIP 102601 TEL FAX CELL 774-8360176 EMAIL virgiliomga@hotmaiIcom ._ ..__ C\ r23 '47 0 -